ADVANCED RESPIRATORY CRITICAL CARE OXFORD MEDICAL PUBLICATIONS Advanced Respiratory Critical Care Oxford Specialist Handbooks published and forthcoming General Oxford Specialist Handbooks A Resuscitation Room Guide Addiction Medicine Perioperative Medicine, Second Edition Post-Operative Complications, Second edition Oxford Specialist Handbooks in Anaesthesia Cardiac Anaesthesia General Thoracic Anaesthesia Neuroanaesthesia Obstetric Anaesthesia Paediatric Anaesthesia Regional Anaesthesia, Stimulation and Ultrasound Techniques Thoracic Anaesthesia Oxford Specialist Handbooks in Cardiology Adult Congenital Heart Disease Cardiac Catheterization and Coronary Intervention Cardiovascular Computed Tomography Cardiovascular Imaging Echocardiography Fetal Cardiology Heart Disease in Pregnancy Heart Failure Hypertension Inherited Cardiac Disease Nuclear Cardiology Pacemakers and ICDs Oxford Specialist Handbooks in Critical Care Advanced Respiratory Critical Care Oxford Specialist Handbooks in End of Life Care End of Life Care in Cardiology End of Life Care in Dementia End of Life Care in Nephrology End of Life Care in Respiratory Disease End of Life Care in the Intensive Care Unit Oxford Specialist Handbooks in Neurology Epilepsy Parkinson’s Disease and Other Movement Disorders Stroke Medicine Oxford Specialist Handbooks in Paediatrics Paediatric Endocrinology and Diabetes Paediatric Dermatology Paediatric Gastroenterology, Hepatology, and Nutrition Paediatric Haematology and Oncology Paediatric Nephrology Paediatric Neurology Paediatric Radiology Paediatric Respiratory Medicine Oxford Specialist Handbooks in Psychiatry Child and Adolescent Psychiatry Old Age Psychiatry Oxford Specialist Handbooks in Radiology Interventional Radiology Musculoskeletal Imaging Oxford Specialist Handbooks in Surgery Cardiothoracic Surgery Hand Surgery Hepato-pancreatobiliary Surgery Oral Maxillo Facial Surgery Neurosurgery Operative Surgery, Second Edition Otolaryngology and Head and Neck Surgery Plastic and Reconstructive Surgery Surgical Oncology Urological Surgery Vascular Surgery Oxford Specialist Handbooks in Critical Care Advanced Respiratory Critical Care Edited by Martin Hughes Consultant in Intensive Care Medicine Royal Infirmary, Glasgow, UK Roland Black Consultant in Intensive Care Medicine Royal Devon and Exeter Hospital Exeter, UK 1 Great Clarendon Street, Oxford OX2 6DP Oxford University Press is a department of the University of Oxford It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide in Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries Published in the United States by Oxford University Press Inc., New York © Oxford University Press 2011 The moral rights of the authors have been asserted Database right Oxford University Press (maker) First published 2011 All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, or under terms agreed with the appropriate reprographics rights organization Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this book in any other binding or cover and you must impose this same condition on any acquirer British Library Cataloguing in Publication Data Data available Library of Congress Cataloging in Publication Data Data available Typeset by Cenveo, Bangalore, India Printed in Great Britain on acid-free paper by Ashford Colour Press Ltd, Gosport, Hampshire ISBN 978–0–19–956928–1 10 Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations The authors and publishers not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breast-feeding v Preface Respiratory disease is the most common reason for admission to intensive care, and advanced respiratory support is one of the most frequently used interventions in critically ill patients A clear understanding of respiratory disease is the cornerstone of high quality intensive care Although a plethora of literature is available, both in print and online, finding the necessary relevant information can be difficult and time consuming This handbook provides comprehensive clinical detail in an easily readable format It is written by practising clinicians and has both in-depth theoretical discussion and practical management advice The book is divided into sections • Section deals with the approach to the patient with respiratory failure – including pathophysiology, investigation, and diagnosis • Section covers non-invasive treatment modalities • Sections and examine invasive ventilation in detail Section considers the principles of mechanical ventilation while section deals with individual ventilator modes • Section discusses the management of the ventilated patient including sedation, monitoring, asynchrony, heart – lung interaction, hypercapnia and hypoxia, complications, weaning and extubation It also has chapters on areas less frequently covered such as humidification, suction, tracheal tubes and principles of physiotherapy • Section is a comprehensive breakdown of each respiratory condition seen in ICU This book is designed to bridge the gap between Intensive Care starter texts and all-encompassing reference textbooks It is aimed at consultants and senior trainees in Intensive Care Medicine, senior ICU nursing staff, consultants in other specialties and allied healthcare professionals who have an interest in advanced respiratory critical care vii Acknowledgements The editors would like to acknowledge Dr Rajkumar Rajendram, Departments of General Medicine and Intensive Care, John Radcliffe Hospital, Oxford, UK, as a reviewer ix Contents Contributors xi Symbols and abbreviations xvii Approach to the patient with respiratory failure Non-invasive treatment modalities Invasive ventilation basics Invasive ventilation modes The ventilated patient Treatment of specific diseases Index 573 73 101 129 209 369 xi Contributors Rebecca Appelboam Kevin Blyth Consultant in Intensive Care Medicine Derriford Hospital, Plymouth, UK Consultant in Respiratory Medicine Southern General Hospital, Glasgow, UK Hugh Bakere Consultant in Respiratory Medicine Royal Devon and Exeter Hospital, Exeter, UK Malcolm Booth Steve Banham Chris Cairns Consultant in Respiratory Medicine Gartnavel General Hospital, Glasgow, UK Consultant in Intensive Care Medicine Royal Infirmary, Stirling, UK Anthony Bateman Registrar in Anaesthesia Royal Infirmary, Glasgow, UK Consultant in Intensive Care and Long Term Ventilation Western General Hospital, Edinburgh, UK Catherine Bateman Consultant Physician United Bristol Hospitals NHS Trust, Bristol, UK Geoff Bellingan Medical Director, Surgery and Cancer Board University College Hospital, London, UK Consultant in Intensive Care Medicine Royal Infirmary, Glasgow, UK Alyson Calder Luigi Camporota Department of Adult Critical Care Medicine Guy’s and St Thomas’ NHS Foundation Trust, London, UK Colin Church Research fellow in Respiratory Medicine Gartnavel General Hospital, Glasgow, UK Ian Colquhoun Consultant in Intensive Care Medicine Western Infirmary, Glasgow, UK Consultant Cardiothoracic Surgeon Golden Jubilee National Hospital, Clydebank, UK Roland Black Julius Cranshaw Consultant in Intensive Care Medicine Royal Devon and Exeter Hospital, Exeter, UK Consultant in Intensive Care Medicine and Anaesthesia Royal Bournemouth Hospital, Bournemouth, UK Alexander Binning xii CONTRIBUTORS Brian Cuthbertson Timothy Felton Professor and Chief of Department of Critical Care Medicine Sunnybrook Health Sciences Centre, Toronto, UK Clinical Research Training Fellow, Respiratory and Intensive Care Medicine University of Manchester, UK James Dale Andrew Foo Clinical Research Fellow Institute of Infection, Inflammation and Immunity, University of Glasgow, UK Registrar in Anaesthesia North Bristol NHS Trust, Bristol, UK Dr Jonathan Dalzell Professor of Medicine Intensive Care Medicine Department, University Hospital of Heraklion, Crete, Greece Clinical Research Fellow British Heart Foundation Cardiovascular Research Centre, University of Glasgow, UK Christopher Day Consultant in Intensive Care Medicine, Royal Devon and Exeter Hospital, Exeter, UK Brian Digby Consultant in Intensive Care Medicine and Anaesthesia Royal Alexandria Hospital, Paisley, UK Graham Douglas Consultant Physician Chest Clinic, Royal Infirmary, Aberdeen, UK Dr Alasdair Dow Dimitris Georgopoulos Dr Tim Gould Consultant in Intensive Care Medicine and Anaesthesia Royal Infirmary, Bristol, UK Dr Duncan Gowans Department of Haematology, Ninewells Hospital, Dundee, UK Ian Grant Consultant in Intensive Care Medicine and Long Term Ventilation Western General Hospital, Edinburgh, UK John Griffiths Consultant in Intensive Care Medicine Royal Devon and Exeter Hospital, Exeter, UK Consultant and Honorary Senior Lecturer Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, UK Tom Evans Dr David Halpin Professor of Molecular Microbiology Institute of Infection, Inflammation and Immunity, University of Glasgow, UK Consultant in Respiratory Medicine Royal Devon and Exeter Hospital, Exeter, UK Dawn Fabbroni Consultant in Intensive Care Medicine Royal Infirmary, Stirling, UK Consultant in Anaesthesia Bradford Royal Infirmary, Bradford, UK Martyn Hawkins 576 INDEX chest X-rays (CXRs) (Cont.) fetal radiation exposure 516 H1N1 influenza 507 interpretation 37–40 interstitial lung disease 470–1 pleural disease 481–2 pleural effusions 485 pleural infection 489 pneumonia 497–9 pulmonary artery hypertension 544 pulmonary embolism 532, 533–4 chlorhexidine 254, 385 chloride shift 21 chocolate blood agar 51 Chromobacterium violaceum 466, 494 chronic bronchitis 428 chronic graft versus host disease (cGvHD) 453 chronic heart failure (CHF) 403, 409–10 chronic lymphocytic leukaemia 452 chronic myeloid leukaemia 452 chronic obstructive pulmonary disease (COPD) 427–37 aetiology 428–9 asynchronies, clinical importance of 271–2 clinical features 430–1 definition 427 diagnosing 431–2 exacerbations 433–4 excessive dynamic airway collapse and tracheobronchomalacia 436–7 extubation failure 353 helium 204, 205 hypercapnia 77–9 long-term ventilation 355–6 monitoring on a ventilator 236 oxygen therapy 77–9 pathophysiology 429–30 PEEP 126 prevalence and mortality 429 prognosis 434–5 role of ICU 434–6 severity assessment 432 terminology 427–8 weaning 337, 344–5 chronic thromboembolic pulmonary hypertension 543 Churg–Strauss syndrome 392, 509 chylothorax 487 ciclosporin 412–13, 474, 569 ciprofloxacin 253, 504, 514 circuit dead space 180 circuits, NIV 91 clarithromycin 58, 504, 566 clindamycin 57, 61, 425, 512 clinical decision making see decision making, clinical clinical examination 28–30 Clinical Pulmonary Infection Service (CPIS) 251 clinical setting 28, 30 clonidine 314, 317, 319, 550 Clostridium difficile 423–4 co-amoxiclav 58, 62, 63, 253, 504, 512 cocaine 373, 390 cognitive dysfunction 364 cognitive errors in diagnosis 64–7 combination oxygen therapy devices 80, 81 comfort factors, PCV vs VCV 117 communication, and patient transfer 325 community-acquired MRSA 505 community-acquired pneumonia (CAP) 488, 493, 495–6 admission to ITU 503 assessment of severity 502–3 chest X-ray 498–9 diagnosis 497 epidemiology 495 failure to respond to treatment 508, 510–11 follow-up 508 H1N1 influenza 507–8 investigation 497–501 microbiology 495–6, 499–501 non-infectious diseases mimicking 509–10 risk factors 496 treatment 503–6 ventilatory management 506 complement fixation tests 53 compliance COPD 435 dynamic monitoring 240–1 oxygenation, improving 292 pressure control ventilation 115–16 static thoracic cage 9–10 typical values 241 volume-controlled ventilation 116 weaning 335 compression ultrasonography (CUS) 537 computerized tomography (CT) 40 acute respiratory distress syndrome 377–8 contrast reactions 40–1 high-resolution 440, 471, 474 lung disease patterns 41–3 pleural disease 482 pleural effusions 485 pleural infection 489 computerized tomography pulmonary angiography (CTPA) 40, 516, 532–3, 534, 535 confirmation bias 66 confusion assessment method for ICU (CAM-ICU) 320–1, 363 congestive cardiac failure 76 connective tissue disease 26 consciousness, level of 28 consolidation 38, 41 constipation 358 context sensitive half times (CSHT) 311 continuous lateral rotation 200 continuous positive airway pressure (CPAP) 95 cardiogenic pulmonary oedema 407 circuit manipulation 80 contraindications 96–7 definition 119 equipment 97–8 indications 69, 96 management 99 physiology 95–6 pneumonia 506 thoracotomy patients 552 continuous veno-venous haemofiltration (CVVH) machines 186 contrast-induced nephropathy (CIN) 41 contrast reactions 40–1 INDEX control of breathing 257–61 convective dispersion, HFOV 158 co-operativity 20 COPD and Asthma Physiology Score (CAPS) 432 coronary artery disease 402 corticosteroids 55, 412, 433–4, 506 cost issues sedatives 311 weaning 333 co-trimoxazole 54, 394, 424, 425, 457 cough 24 assisted 227–8, 358 crack cocaine 26, 390 crackles 29–30 creatine kinase (CK) 54 crepitations 29–30 critical illness polyneuromyopathy (CIP) 361 Cryptococcus neoformans 425 cryptogenic fibrosing alveolitis (CFA) 469 cryptogenic organizing pneumonia (COP) 470, 477–8, 509 cuff leak test 350–1 cuff pressure 210 cuffs 217, 254 cuirass ventilators 94, 104 culture blood 52–3 mycobacteria 60 sputum 51–2 CURB 65 tool 502 cyanide poisoning 75 in smoke 461 cycling 110 assist control ventilation 140 neurally adjusted ventilatory assist 178, 179 non-invasive ventilation 86 pressure support ventilation 144, 146–7 problems 110 cyclizine 457 cyclophosphamide 394, 413–14, 439, 442, 474 cystic fibrosis (CF) 25, 527–8, 567–8 cystine–lactose–electrolyte deficient (CLED) agar 51 cysts, lung 42 cytomegalovirus (CMV) 422–3 cytomegalovirus negative blood 456 D D-dimers 532 daptomycin 61 dead space 18–19 airway pressure release ventilation 153 alveolar 18–19 anatomical 18, 242 apparatus 18 circuit 180 heat and moisture exchangers 223 hypercapnia while on a ventilator 297 monitoring 242–3 physiological 19, 242 pressure-controlled ventilation 136–7 decannulation, tracheostomy tubes 220 decelerating flow pattern 166 decision making, clinical 67–8 cognitive errors, reducing 66–7 cognitive failure 65–6 diagnosis, importance of 64–5 decremental PEEP trial 126 deep vein thrombosis 200, 201, 537, 540 delirium 320–2, 363 deoxyhaemoglobin (HHb) 20 dependency, ventilator 333 depression 363 desquamative interstitial pneumonia (DIP) 470 dexamethasone 351, 352 dexmedetomidine 313, 314 diagnosis cognitive errors, reducing 66–7 cognitive failure 65–6 decision making and 64–8 importance of 64–5 diaphragm 4, diaphragm electrical activity (EAdi) 178, 179, 180, 181, 182 diaphragm rupture 560 diazepam 273, 518 diclofenac 550 diet see nutrition differential diagnosis 67 diffuse alveolar haemorrhage causes 389, 390 investigation 392–3 presentation 388 diffusing capacity of the lung for carbon monoxide (DLCO) 36 diffusion coefficient for carbon monoxide (KCO) 36 digoxin 548 dipyridamole 547 disability 361–2 discharge planning, COPD 436 discontinuation of mechanical ventilations 333 displaced tracheostomy tube 219 disseminated intravascular coagulation 54 dobutamine 406–7, 522, 547, 548, 552 dopamine 522, 547–8 double-lumen tubes (DLTs) 554–5 double triggering 263, 266 doxycycline 63 Dräger, Heinrich 105 Dräger Oxylog 2000/3000/3000 plus ventilators 330–1 Drinker, Phillip 103 drotrecogin alfa (activated protein C) 505 drowning 464–5 drug history 26–7 drug-induced hypersensitivity pneumonitis 510 drug-induced lung disease (DILD) 438–43 diagnosis 439–40 drugs commonly associated with 441–3 epidemiology 438–9 investigation 440 management 440–1 pathophysiology 438 drug resistance 505 dry drowning 465 dual-control ventilatory modes 165–6, 234 Duchenne muscular dystrophy (DMD) 451 Dutch hypothesis, COPD 429 dynamic compliance dynamic hyperinflation 92, 143, 176, 400 577 578 INDEX dynamic ventilation loops 237–9 dyspnoea see breathlessness E echocardiography cardiogenic pulmonary oedema 405 peripartum cardiomyopathy 522 pulmonary artery hypertension 544–5 pulmonary embolism 536–7 eclampsia 517–20, 528 Ehlers–Danlos syndrome 25 electrocardiograph gated scanning, integration with CT 40 electrocardiography cardiogenic pulmonary oedema 405 pulmonary artery hypertension 544 pulmonary embolism 531 elimination rate, sedatives 310 emboli 303–4 see also pulmonary embolism emergency departments (EDs) 332 emphysema 427–8, 484 empyema 488, 489–90, 511 endobronchial ultrasound (EBUS) 47 endoscopic repair, broncho-pleural and alveolo-pleural fistulae 249 endotoxin detection 55 endotracheal tubes (ETTs)/ intubation 210–12 asynchronies 270 automatic tube compensation 166–7 extubation see extubation high-frequency oscillatory ventilation 162–3 history 102, 104–5 mechanical complications 211–12 sudden deterioration on a ventilator 302–3 ventilator-associated pneumonia 210–11 Engstrom, CarlGunnar 105, 106 enoximone 407 entecavir 423 entrainment of respiratory rhythm to ventilator rate 260 environmental factors, COPD 428 environmental history 27 enzyme-linked immunosorbent assay (ELISA) 53 eosinophilic lung disease 509 epidural analgesia 550 epoprostenol 380, 546, 547 Epworth Sleepiness Scale 447 ertapenem 514 erythromycin 61, 63, 504, 566 etanercept 420 ethambutol 424, 526 Euro-Qol five-dimensions (EQ-5D) 367 examination, clinical 28–30 excessive dynamic airway collapse 436–7 exercise, ventilation as 278–80 exhaustion 70–1 exotocin PVL test 55 experimental microbiology tests 55–6 expiratory positive airways pressure (EPAP) 85, 119 see also positive end expiratory pressure expiratory resistance 11 expiratory trigger 263, 267, 270 external negative pressure ventilation 93–4 extracorporeal membrane oxygenation (ECMO) 183–7 AVCO2R 187 centre 183 circuit 184–5 complications 186 contraindications 183 patient management 186 patient selection 183 results 186–7 transfer of patients 329 extrapulmonary causes of respiratory failure 444–51 approach to patients 446–8 causes 444–5 chronic neuromuscular diseases 450–1 control of respiration 444 Guillain–Barré syndrome 450 obesity hypoventilation 450 treatment 448–9 extrapulmonary shunt 18 extravascular lung water (EVLW) 193, 194 extubation 350–3 failure 351–3 laryngeal oedema 350–1 pre-conditions 350 process 351 F facemasks 98 FACTT study 193–4 famciclovir 422 fat embolism 303 feedback systems, effects of mechanical ventilation on 257–60 fenestrated tracheostomy tubes 217 fentanyl 273, 305, 313, 315 fetal haemoglobin (HbF) 20 fetal monitoring 517 fetal radiation exposure 516 FEV1 35 FEV1/FVC 36 filters 92, 163, 223, 538, 539 FiO2 oxygen therapy 80, 81 oxygenation, improving 282–3 weaning 336–7 fixed performance oxygen delivery devices 79 flash pulmonary oedema 403 flow cycling 110 flow generation, CPAP 97 flow patterns produced by ventilators 166 flow–time curves, monitoring 236–7 flow–time profile, volume-controlled ventilation 112 flow triggering 109 flow volume loops 36, 237 flow waveform triggering 109 flows, pressure control ventilation 115 flucloxacillin 54, 57 fluconazole 59, 425, 525 flucytosine 425 fludarabine 455, 456, 457 fluid balance 381–2, 545 fluid clearance 198 fluid homeostasis, ventilator-associated complications 255 INDEX fluid management after thoracic surgery 550 fluid management in acute respiratory failure 193–5, 294, 507 fluid overload 394 fluoroquinolone 253, 504, 505, 514, 525, 566 follow-up from intensive care 365–7 fondaparinux 539 forced expiratory volume in second (FEV1) 35 forced vital capacity (FVC) 35 Fothergill, John 102 Francisella philomiragia 466, 494 fungi 59 furosemide 194, 406, 408, 522 fusidic acid 54 FVC 35 G gambler’s error 66 ganciclovir 423 gas exchange 119 gas transport 19–21 gastric contents, aspiration of 466–7 gastric dilatation 90 genetic susceptibility, COPD 428–9 Geneva score 531 gentamicin 514, 525, 566 getuzumab 418–19 Glasgow Coma Score (GCS) 71 glomus cell glyceryl trinitrate (GTN) 406, 409 golimumab 420 Goodpasture’s disease 389, 390, 394 graft versus host disease 453 Gram-negative organisms 58–9 Gram-positive organisms 56–7 Gram staining 50 great vessel injuries 559–60 ground glass opacity (GGO) 38, 41, 42 Guillain–Barré syndrome 450 H H1N1 influenza 507–8, 525 haematological malignancy in ICU 452–9 admission to ICU 458–9 complications of therapy 453–5 medications 457–8 neutropenic patient 455–6 specialized blood products 456–7 treatment 452–3 haematology 44, 53–4 cardiogenic pulmonary oedema 405 haemoglobin 20 abnormal 20–1 dissociation curve 20 microbiology laboratory 53 Haemophilus influenzae 58 haemoptysis 24, 555 haemothorax 487–8, 558 Haldane dead space 78 haloperidol 318, 319, 322 hamburger shift 21 Hamman–Rich syndrome 469, 476, 510 hand ventilation 302 hang-up phenomenon 263, 268 Hayek oscillators 94 health-care associated pneumonia 4983 health-related quality of life (HRQL) 364–5 heart failure 402 heart–lung interactions 275–81 heart–lung transplantation 354 heat and moisture exchangers (HMEs) 223, 224, 273, 357 heated humidifiers (HHs) 222–3, 224, 273 heated water humidifiers (HWHs) 254, 357 Heliox 204–5, 399 helium 204–5 HELLP syndrome 519–20 helmets 91, 98, 270, 273 Henderson–Hasselbach equation 33 Henoch–Schönlein purpura 392 heparin 184, 439, 462, 522 pulmonary embolism 524, 537–8, 539, 540 hepatitis B 423 hepatopulmonary syndrome (HPS) 565 hereditary haemorrhagic telangiectasia (HHT) 564–5 Hering–Breuer (inflation) reflex 259, 260 heroin 26, 306, 439 high air flow oxygen enrichment (HAFOE) masks 79 high flow oxygen delivery devices 80–1 high-frequency oscillatory ventilation (HFOV) 158–64 acute respiratory distress syndrome 385 complications and limitations 162 H1N1 influenza 507 indications 159–60 parameters 158–9 practicalities 160–1 recruitment manoeuvres 161–2 reported advantages 162 troubleshooting 162–3 high-frequency ventilation (HFV) 107, 247–8 high-resolution computerized tomography (HRCT) 440, 471, 474 Hippocrates 102 HIV infection 525–6 HLA-matched platelets 456 hobbies 27 home life 27 home ventilation see longterm ventilation hoods 91 Hooke, Robert 102 hospital-acquired pneumonia (HAP) 488, 493, 513–14 Hospital Anxiety and Depression Scale (HADS) 367 Hudson masks 80, 81 human platelet antigenmatched platelets 456 Humane Society, Amsterdam 102 humidification 222–4 assessment 222 asynchronies 270 CPAP 98 high frequency oscillatory ventilation 162 long-term ventilation 357 non-invasive ventilation 91 physiotherapy 228 humidified oxygen therapy 81 Hunter, John 102 hydralazine 518, 522, 547 hydrocortisone 398 579 580 INDEX hypercapnia acceptable levels 300 assessment 296 asthma 395, 400 causes 22, 296–7 COPD 77–9 influence on breathing long-term ventilation 355 management 298 permissive 383 physiological consequences 297, 299 pressure support ventilation 149–50 risk of 78 strategy 300 titrating settings in APRV 155 ventilatory support, indications for 70 whether or not to correct 297 while on a ventilator 296–300 hyperinflation, manual 228 hyperventilation 34 hypoalbuminaemia 54 hypocalcaemia 54 hypocapnia 3, 155 hyponatraemia 54 hypotension 90 hypothermia 465, 466 hypothesis generation 67 hypoventilation, obesity 450 hypoxaemia asthma 395 oxygen therapy, indications for 74–5 pressure support ventilation 150 ventilatory support, indications for 70 hypoxaemic respiratory failure 96 hypoxia airway pressure release ventilation 155 causes 22 influence on breathing 3–4 normoxaemic 75 hypoxic lung disease 543 hypoxic pulmonary vasoconstriction 13–14 hysteresis 284 I I:E ratio 112, 115, 155, 156 Ibsen, Bjørn 105, 106 ibuprofen 380 idiopathic interstitial pneumonias 469–70 idiopathic pulmonary fibrosis (IPF) 469, 473–6 iloprost 546 imipenem 504, 514 immunocompromised host, pneumonia in the 512–13 immunological changes in pregnancy 516 immunology 45 immunosuppressants 411–17, 422–6 imposed load 336 impregnated tracheal tubes 211 incentive spirometry 227 independent lung ventilation 148 indometacin 522 ineffective triggering 263, 265 infection control of 163, 325 neutropenia 455–6 inferior vena cava (IVC) filters 538, 539 inflammatory disorders 509 inflammatory modulation 198 inflation reflex see Hering– Breuer (inflation) reflex infliximab 420 influenza bacterial filters 223 H1N1 507–8, 525 microbiology laboratory 59 in pregnancy 525 secondary to immunomodulatory and biologic therapy 423 inhalational injury 460–7 aspiration 467 aspiration of gastric contents 466–7 near-drowning 464–6 smoke inhalation 460–3 thermal injury to the airway 463–4 inotropic therapy 406 inspiratory airflow patterns 292–3 inspiratory flow, pressure-controlled ventilation 135 inspiratory flow rate 235 inspiratory occlusion pressure 242 inspiratory positive airways pressure (IPAP) 84, 85 inspiratory pressure 285, 337 inspiratory resistance, physiological response to 11 inspiratory time extension 263, 267 oxygenation, improving 285 pressure control ventilation 114–15 volume-controlled ventilation 112 inspiratory to expiratory cycling in pressure support 235–6 inspiratory trigger delay 263, 264 inspired oxygen concentration 383–4 insulin 439 intercostal muscles (ICMs) interfaces see patient interfaces intermittent mandatory ventilation (IMV) 107, 130 intermittent positive pressure breathing 227 intermittent positive pressure ventilation (IPPV) 69 interstitial lung disease (ILD) 468–80 definitions and nomenclature 468–70 diagnostic and management principles 470–3 interstitial opacities 41–2 intra-aortic balloon pumps (IABPs) 407–8 intracellular acidosis 298–300 intracranial pressure 122 intrapulmonary shunt 18 intrathoracic fluid 39 intrathoracic injuries 558–60 intrathoracic pressure (ITP) haemodynamic effects of changes in 277–8 negative swings in end inspiratory ITP 278, 279 pulmonary vascular disease 549 intrinsic PEEP (PEEPi) 11, 122–3, 135–6 assist control ventilation 143 asynchronies 263–9 COPD 436 INDEX effects 123 extrinsic PEEP and 123, 124 measurement 123 monitoring 236–7, 241–2 oxygenation, improving 286, 295 invasive long-term ventilation 357–8 invasive ventilation development 102–8 PEEP 119–27 pressure vs volume delivery 111–18 triggering and cycling 109–10 invasive ventilation modes adaptive support ventilation 170–3 adjuncts to ventilation 188–207 airway pressure release ventilation 151–5 assist control ventilation 140–3 BiPAP 151, 155–7 extracorporeal membrane oxygenation 183–7 high frequency oscillatory ventilation 158–64 neurally adjusted ventilatory assist 178–82 pressure-controlled ventilation 135–9 pressure support ventilation 144–50 proportional assist ventilation 174–7 software enhancements 165–9 synchronized intermittent mandatory ventilation 130–4 inverse ratio ventilation (IRV) 138, 384 investigations, facilitation of 71–2 investment bias 66 iodine 373 ipratropium bromide 398 iron lungs 93, 103–4 irradiation, specialized blood products 456 isoflurane 401 isoniazid 421, 424, 526 isoprenaline 548 ivermectin 426 K Kaltostat® 219 Kaplan–Meier survival curves 359, 360 Karnofsky Performance Status (KPS) and Karnofsky index 367 Kartegener’s syndrome 25 ketamine 401 ketoconazole 380 kidney injury, acute 386 Killip classification of acute heart failure 402 kinetic therapy 200 knowledge base 344 Kussmaul respiration 34 kyphoscoliosis 355 L l-tryptophan 439 labetalol 518 lamivudine 423 Langerhans cell histiocytosis 571 laryngeal oedema 350–1, 352 Lassen, Professor 106 Lavoisier, Antoine 74, 102 leaks asynchronies 269 broncho-pleural and alveolo-pleural fistulae 246–7 classification 247 dual-control ventilatory modes 166 high frequency oscillatory ventilation 161 long-term ventilation 357 non-invasive ventilation 89, 92 pneumothorax 246 pressure-controlled vs volume-controlled ventilation 117 proportional assist ventilation 175 leflunomide 414, 510 left ventricle (LV) ejection 277–8 failure 352 function 277 performance 122 left ventricular assist devices (LVADs) 408 Legionella 51, 52, 55, 58 Lemierre’s syndrome 490 leukaemia 452 levofloxacin 457, 504, 514 levosimendan 407, 548 lidocaine 215 Light’s criteria 484 limiting 110 linezolid 57, 61, 63, 253, 504, 505, 514 lisinopril 439 lisofylline 380 liver function tests 54 loading, respiratory 335–6 long-term ventilation (LTV) 354–8 aims 356 COPD 432 indications 354 initiation 356 methods 356–8 patient selection 355–6 presentation 355 lorazepam 273, 305, 312, 314 low molecular weight heparin (LMWH) 522, 524, 537–8, 539, 540 Lowenstein–Jensen medium 52 LTV 1000 ventilator 331 lung biopsy 378–9, 440, 511 lung function 378 lung mechanics, pathophysiology of 11–12 lung protective ventilation (LPV) strategy 244, 245 lung recoil lung resection 248 lung rest 186 lung transplantation 568–9 acute respiratory distress syndrome 373 cystic fibrosis 568 idiopathic pulmonary fibrosis 474, 476 lung ultrasound 43–4 lung volume alterations in pregnancy 515 haemodynamic effects of changes in 275–7 pulmonary vascular disease 549 respiratory resistance 10 lymphangioleiomyomatosis 571–2 lymphocytosis 53 lymphoid interstitial pneumonia 470 lymphoma 452 lymphopenia 53, 54 M McConkey agar 51 machine rate 112, 114 magnesium sulphate 398, 518–19, 522, 528 magnetic resonance imaging (MRI) 43, 331–2 malignancy, signs indicating 29 581 582 INDEX malignant arrhythmias 304 manual hyperinflation (MHI) 228 manual physiotherapy techniques 227 Marfan’s syndrome 25 massive blood transfusion 372 massive haemoptysis 555 maximal inspiratory pressure 242 mean airway pressure 138 mean alveolar pressure 138 mean arterial pressure (MAP) 283 mean pressure (mPaw) 232 melatonin 323 6-mercaptopurine 411–12 meropenem 253, 504, 514 metabolic acidosis 34–5, 54 metabolites, active 311 methadone 306 methaemoglobin (metHb) 21 meticillin-resistant Staphylococcus aureus (MRSA) 56 methotrexate 373, 414–15, 439, 442 methotrexate pneumonitis 415 methylprednisolone 393–4, 453, 457, 474, 477, 478 metoclopramide 320, 457 metoprolol 522 metronidazole 62, 63, 424, 512, 525 microbiology 44, 49 antibiotic therapy 61–3 blood cultures 52–3 blood tests 53–5 experimental/less easily available tests 55–6 fungi 59 Gram-negative organisms 58–9 Gram-positive organisms 56–7 mycobacteria 60–1 polymerase chain reaction 55 sputum 49–52 surveillance cultures 56 urinary antigens 55 viruses 59–60 microscopic polyangiitis 391–2, 394 microscopy, sputum 49–50 microthromboembolic disease 474 midazolam 273, 305, 312, 314, 319 milrinone 407, 522, 546–7, 548 mini-tracheostomy 221 minute ventilation (MV) 112, 296–7 minute volume, monitoring 232 mitomycin 373 mixed essential cryoglobulinaemia 392 mixed venous oxygen saturation, increasing 293–4 mobilization 226 molecular diffusion, HFOV 158 monitoring 231–43 accuracy 231 extracorporeal membrane oxygenation 184 high frequency oscillatory ventilation 161 measurements 231–2, 242–3 neurally adjusted ventilatory assist 180 respiratory system mechanics 240–2 transducers 231 transfer of patients 327 ventilation curves 232–7 ventilation loops 237–40 morbidity outcome, ARDS 387 morphine 273, 305, 315, 319, 406, 408, 439 Morris, William 104 mortality outcomes 359–60 acute respiratory distress syndrome 386 motor neurone disease (MND) 354, 450 mouthpieces 91 moxifloxacin 504, 514 MRSA 56 mucolytics 228 mucous plug 303 multiple inert gas elimination technique (MIGET) 16–17 Murray lung injury score 370–1 muscle wasting 361 myasthenia gravis 528 mycobacteria 52, 60–1 Mycobacterium tuberculosis 424 mycophenolate mofetil (MMF) 415–16 myocardial contusion 559 myocardial disease 347 myocardial infarction (MI) 304, 402, 403 myocardial injury 559–60 myocardial ischaemia 403 myocardial stunning 410 myotonic dystrophy 451 N N-acetylcysteine (NAC) 228, 245, 380, 462, 474 nasal bridge pressure sores 89–90 nasal cannulae 81 nasal masks 91, 98 nasal pillows 91 nasal prongs 91 National Patient Safety Alert 97 near-drowning 464–6, 494 nebulization 228 negative pressure ventilation 103–4 neoplasms 509 nesiritide 547 neurally adjusted ventilatory assist (NAVA) 107, 178–82 asynchronies 271 indications 179–80 practicalities 181–2 problems 180–1 triggering 109 troubleshooting 182 neurofibromatosis 25, 572 neuromechanical feedback, effects of mechanical ventilation on 259–60 neuromechanical inhibition, effects of mechanical ventilation on 260 neuromuscular blockade 163, 382 neuromuscular disorders 355 neuromuscular investigations 48 neutropenia 455–6 neutropenic sepsis 453–5 neutrophil counts 53 neutrophilia 54 nicotine patches 306 nifedipine 518, 547 nitric oxide (NO) 196–7 acute respiratory distress syndrome 380, 527 methaemoglobin 21 pregnancy 527 pulmonary vascular disease 546, 547 ventilator-induced lung injury prevention 245 nitrofurantoin 373, 439, 442–3 INDEX nitroprusside 547 no-fault errors in diagnosis 64 nocardia 424 nodular opacities 42 non-aerated lung, signs indicating 30 non-invasive respiratory support 84 CPAP 94–9 oxygen therapy 74–83 see also external negative pressure ventilation; non-invasive ventilation non-invasive ventilation (NIV) 84–93 acute respiratory distress syndrome 385 asthma 399 extubation failure 353 history 107 indications 69, 87–8 interfaces 270 long-term ventilation 356–7 nomenclature 85 outside the ICU 89 pneumonia 506 practicalities 90–2 pressure-control 88–9 problems 89–90 setting up 92 troubleshooting 92–3 ventilator-associated pneumonia 253 weaning 344–5 non-rebreathing masks 80, 81 non-respiratory symptoms 27–8 non-specific interstitial pneumonia (NSIP) 470 noradrenaline 407, 547, 548, 551 normoxaemic hypoxia 75 North American-European Consensus Conference (NAECC) 371 NovaLung 206 Nuffield, Lord 104 nutrition 28 acute respiratory distress syndrome 382 neutropenic diet 455 nystatin 394, 457 O obesity hypoventilation 450 obstetric emergencies 77 obstructive disease 12 obstructive sleep apnoea (OSA) 450 occlusion 211, 223, 248 olanzapine 322 ondansetron 457 onset of symptoms, speed of 24–5 opacification chest X-rays 38–9 computerized tomography 41–2 open-lung biopsy (OLB) 378–9 organ transplantation 26 see also specific organs orlistat 450 oro-nasal masks 91 orthodeoxia 23 orthopnoea 23 oseltamavir 423, 507 outcomes 359–65 acute respiratory distress syndrome 386–7 mortality 359–60 non-mortality 361–5 smoke inhalation 463 overlay tool, NAVA 182 over-support, PSV 147 oxygen carriage in the blood 20 cascade 19, 301 consumption, reducing 71, 293 cylinders 79–82 delivery 122, 293 delivery devices 79–81 influence on breathing 3–4 non-invasive ventilation 92 reservoir 80 smoke inhalation 460 therapy see oxygen therapy toxicity 75–6 oxygen therapy 74, 82 asthma 397 capacity of oxygen cylinders 81–2 COPD 77–9, 432, 434 detrimental clinical effects 76–7 failure to respond to 82 indications 74–5 oxygen delivery devices 79–81 smoke inhalation 462 oxygenation effects of mechanical ventilation on 282–95 methods to improve 282–95 index (OI) 32, 232 oxygenator, ECMO 184 oxyhaemoglobin (HbO2) 20 P PaCO2 33–4 pressure-controlled vs volume-controlled ventilation 116 stimulus 258 pain assessment 309–10 palivizumab 423 pancreatitis 487 Panton Valentine leukocidin (PVL) staphylococcal infection 57 PaO2 32–3 pressure-controlled vs volume-controlled ventilation 116 stimulus 258–9 PaO2/FiO2 ratio 32 paracetamol 550 parainfluenza 423 paralysis 295 parapneumonic effusions 489 paraquat poisoning 77 partial liquid ventilation 207 particulate matter, in smoke 461 Passy-Muir valves 220 past medical history 25–6 pathological central respiratory drive 180 patient interfaces CPAP 98 long-term ventilation 356 non-invasive ventilation 90–1 patient–ventilator interaction 260–1 peak airway pressure 233 peak expiratory flow rate (PEFR) 36 peak inspiratory flow rate (PIFR) 79 peak pressure 232, 233 pendelluft, HFOV 158 penetrating chest wounds, management of 561–2 pentoxifylline 245, 380 peramivir 507 percutaneous dilational tracheostomy (PDT) 214 perfluorocarbons 207 perfusion, distribution of 15 pericardial tamponade 559 peripartum cardiomyopathy 521–2 peripheral chemoreceptors 3–4 permissive hypercapnia 383 pets 26 583 584 INDEX pH 33–4 stimulus 258–9 phaeochromocytoma 403 pharmacodynamics, sedatives 310–13 pharmacokinetics, sedatives 310–13 phenylephrine 548 phenytoin 414, 439, 518 Phigh 153 phosphodiesterase inhibitors 407 physical impairment 361–2 physiological dead space 19, 242 physiological impairment 363–4 physiotherapy 226–30 breathlessness, management of 229 on-call 230 positive pressure adjuncts 227–8 rehabilitation 229 speaking valves 229–30 techniques 226–7, 228–9 weaning and tracheostomy management 229 picture archiving and communication systems (PACS) 39 pink puffers 428 Pinsp 137 piperacillin 58, 253, 504, 514 plateau pressure, monitoring 232, 233 platelet transfusion thresholds 456–7 plethysmography 36 pleural disease 481–92 chest drains 490–2 diagnosis 481–2 haemothorax 487–8 management 482–3 pleural effusion 484–7 pleural infection 488–90 pneumothorax 481 surgical emphysema 484 tension pneumothorax 483 pleural effusions 484–7 pleural infection 488–90 pleural injuries 558 pleural involvement, signs indicating 29 pleural tips 487 pleurectomy 249 pleurodesis 248–9 Plow 154 Pmus waveform 260–1 pneumococcal serology 55 pneumococcus 56 pneumocystic stains 51 Pneumocystis jirovecii pneumonia (PJP) 59 secondary to immunomodulatory and biologic therapy 425 corticosteroids 412 cyclophosphamide 414 pregnancy 526 pneumonia 493–514 acute respiratory distress syndrome 372 aspiration 372, 511–12 asynchronies, clinical importance of 272 bacterial 512, 524–5 cavitating 38 community-acquired see community-acquired pneumonia history 25 hospital-acquired see hospital-acquired pneumonia humidification devices 223–4 in immunocompromised host 512–13 pathogenesis 493–4 Pneumocystis jirovecii see Pneumocystis jirovecii pneumonia surfactant 202 weaning 337 Pneumonia Severity Index (PSI) 502 pneumothorax 246, 481, 558 acute respiratory distress syndrome 385 chest ultrasound 43 chest X-ray 38 sudden deterioration on a ventilator 303 tension 483, 558 poliomyelitis Copenhagen epidemic (1952) 105–6 history 25 iron lungs 93, 94, 103–4 polymerase chain reaction (PCR) 53, 55 polymyxin 254 polysomnography (PSG) 48 portable transport ventilators 330–1 positional breathlessness 23 positioning, patient oxygenation, improving 294 physiotherapy 226 prone see prone positioning positioning, tracheal tubes 211 positive end expiratory pressure (PEEP) 119–27 acute respiratory distress syndrome 383 airway pressure release ventilation 154–5 alveolar recruitment and high PEEP 191–2 asthma 400 contraindications 127 COPD 436 definitions 119 intrinsic see intrinsic PEEP neurally adjusted ventilatory assist 182 oxygenation, improving 285–8 physiological effects 119–22 pneumonia 506 pressure-controlled ventilation 138 setting 123–7 thoracotomy patients 552 valves 97–8 weaning 336–7 positive pressure adjuncts 227–8 positive pressure ventilation 105 posoconazole 457 post-coronary artery bypass graft effusions 486–7 post-extubation stridor 211–12, 352 post-operative care adaptive support ventilation 171–2 PEEP 127 synchronized intermittent mandatory ventilation 132 post-polio syndrome 25 post-thoracotomy respiratory failure 551–3 post-traumatic stress disorder (PTSD) 363–4 posterior probability error 66 posture, effect on respiratory muscles 5–6 povidone iodine 254 pre-eclampsia 517–20, 528 prednisolone 394, 398, 425, 477, 478 pregnancy 515–28 acute respiratory distress syndrome 526–7 amniotic fluid embolism 520–1 INDEX bacterial pneumonia 524–5 eclampsia 517–20 exacerbation of underlying disease 527–8 fetal monitoring 517 HELLP syndrome 519–20 history 27 HIV infection 525–6 influenza infection 525 oxygen therapy, detrimental effects of 77 peripartum cardiomyopathy 521–2 physiological changes 515–16 pre-eclampsia 517–20 pulmonary embolism 523–4 pulmonary oedema 523 tocolysis 522–3 viral pneumonitis 525 preload, PEEP 121 premature closure 66 pressure control, monitoring 233–4 pressure control ventilation (PCV) 111, 114–18, 135–9 acute respiratory distress syndrome 384 advantages 137 asthma 400 disadvantages 137 inverse ratio ventilation 138 set up 137–8 spontaneous breathing during 138–9 volume-controlled ventilation vs 116–18, 136, 137 pressure cycling 110 pressure ramp 147 pressure releases 153 pressure rise time 269 pressure sores, nasal bridge 89–90 pressure support, monitoring 234 pressure support ventilation (PSV) 144–50 cycling 110, 147 expiratory trigger sensitivity 148 indications 144 long-term ventilation 356 physiological effects 145 practicalities 147–9 problems with pressure delivery 147 problems with synchronization 145–7 synchronized intermittent mandatory ventilation 132 troubleshooting 149–50 weaning 149, 344 pressure–time curves 233–6 pressure triggering 109 pressure–volume loop 237–40 pressurized metered dose inhalers (pMDIs) 398 Priestley, Joseph 74, 102 prilocaine 21 primaquine 425 primary ciliary dyskinesia 25 primary pulmonary hypertension 14 probenecid 414 progress of respiratory failure, review of 30–1 prone positioning 189–90 rotational therapy and 200–1 prone ventilation 107 prophylaxis PEEP 127 post-operative CPAP 96 propofol 305, 312, 314, 318, 319 propofol infusion syndrome 314 proportional assist ventilation (PAV) 169, 174–7 asynchronies 271 indications 175 limitations 175–6 principles 174 proportionality 174–5 set up 176 troubleshooting 176–7 weaning 344 propylthiouracil 373, 390 prostaglandin E1 (PGE1) 379 protected specimen brush (PSB) 47, 252 Pset 137 pseudochylothorax 487 Pseudomonas aeruginosa 58–9 pulmonary angiography 48 pulmonary arterial hypertension (PAH) 541 diagnosis 543–5 epidemiology 543 pathophysiology 541–2 treatment 545–9 ventilatory management 549 pulmonary arteriovenous malformations (PAVMs) 564–5 pulmonary artery catheter 47 pulmonary arterial hypertension 545 pulmonary blood flow 13 pulmonary circulation 12–14 pulmonary elasticity 8–9 pulmonary embolectomy 538 pulmonary embolism (PE) 487, 529–30 classification 529 diagnosis 530–1 diagnostic imaging tests 532–7 epidemiology 529 investigation 531–2 medical management 537–8 pathophysiology 529 pregnancy 523–4 prevention 539–40 rotational therapy 200, 201 ventilatory management 538–9 pulmonary function tests (PFT) 35–6 pulmonary haemorrhage 388–90 pulmonary haemosiderosis alveolar haemorrhage 389–90 pulmonary hypertension 14 see also pulmonary vascular disease pulmonary injuries 558–9 pulmonary lymphatics 255 pulmonary oedema cardiogenic see cardiogenic pulmonary oedema chest X-rays 39 pregnancy 523 reducing 294 re-expansion 554 sudden deterioration on a ventilator 304 pulmonary oxygen toxicity 76 pulmonary–renal syndrome 388 pulmonary thromboembolism (PTE) 42–3, 537 585 586 INDEX pulmonary vascular disease 541–9 diagnosis 543–5 epidemiology 543 pathophysiology 541–3 treatment 545–9 ventilatory management 549 pulmonary vascular resistance (PVR) 12, 276–7 pulmonary vasculitis 388–94 causes 389–90 differential diagnosis 388 presentation 388 treatment 393–4 pulmonary vasoconstriction, hypoxic 13–14 pulmonary vasodilator therapy 546–7 pulmonary venous hypertension 543 Pulmotor 105 pulse oximetry 31 pump, ECMO 184 pyrazinamide 424 pyridoxine 424 Q quality of life 364–5 quantiferon-TB gold 60–1 quasi-static pressure– volume loop 239 R radiology 331 acute respiratory distress syndrome 377–8 in pregnancy 516 see also chest X-rays radionuclide lung scintigraphy, fetal radiation exposure 516 rainout 222–3 rasburicase 457 reactive oxygen species (ROS) 76 recreational drug use 26–7 recruitment manoeuvres (RM) alveolar recruitment and high PEEP 191–2 high frequency oscillatory ventilation 161–2 oxygenation, improving 289–91 re-expansion pulmonary oedema 554 referral to ICU asthma patients 396–7 chronic heart failure 409–10 pneumonia 503 reflex feedback 259–60 rehabilitation 229 re-intubation 353 remifentanil 273, 313, 315, 550 renal failure 54 renal perfusion 122 renal replacement therapy 54 renal system, ventilatorassociated complications 255 resistance 10–11 monitoring 240–1 pressure control ventilation 115 typical values 241 weaning 336 respiratory bronchiolitisinterstitial lung disease (RB-ILD) 470 respiratory centre 2–3 respiratory control 444 respiratory disease, investigation of 31–48 arterial blood gas analysis 32–5 blood tests 44–6 bronchoscopy 46–7 chest ultrasound 43–4 chest X-ray 36–9 computerized tomography 40–3 magnetic resonance imaging 43 microbiology 44 neuromuscular investigations 48 pulmonary angiography 48 pulmonary artery catheter 47 pulmonary function tests 35–6 pulse oximetry 31 sleep investigations 48 respiratory dysfunction, extubation failure 352–3 respiratory effort initiating a 337 proportional assist ventilation 175 respiratory failure acute 193–5 definitions 22 detection 133 examination 28–30 extrapulmonary causes see extrapulmonary causes of respiratory failure history 23–8 hypercapnia, causes of 22 hypoxaemic 96 hypoxia, causes of 22 investigation of respiratory disease 31–48 review of progress 30–1 respiratory muscles 4–6 intrinsic properties 259 strength and tone 131 respiratory pattern, examination 29 respiratory physiology and pathophysiology respiratory rate alterations in pregnancy 515 oxygenation, improving 291 pressure-controlled ventilation 138 respiratory syncytial virus (RSV) 59, 423 respiratory system assessment 29–30 respiratory system mechanics 7–21 monitoring 240–2 patient–ventilator interaction 260 respiratory system resistance 10–11 restrictive disease 11–12 review areas, chest X-rays 39 Reynolds number 204 rheumatoid arthritis 26 rhinitis 90 rib fractures 557 ribavarin 423 ribcage muscles Richmond Agitation– Sedation Scale (RASS) 308–9 rifampicin 54, 58, 424, 504, 526 Rig Veda 102 right heart catheterization 406 right ventricular infarction 409 right ventricular performance 121 Riley three-compartment ˙Q ˙ model of V/ relationships 15–16 rise time 85, 235 rituximab 419–20, 510 rocking beds 94 rotational therapy 200–1 RotoRest 200 runaway 176 Rush valves 220 INDEX S salbutamol 198, 381, 396, 398, 439 SAPS II trial 432 sarcoidosis 478–80 Scheele, Carl Wilhelm 74 sclerosis, systemic 26 search satisfying error 66 secondary pulmonary hypertension 14 sedation 305–23 acute respiratory distress syndrome 382 assessing requirements 307–10 asthma 399 asynchronies 273 delirium 320–2 drugs 310–15 high frequency oscillatory ventilation 163 holds 316 for insomnia cycle 319 monitors 316 optimizing 306–10 practical aspects 315–19 practice and outcome, relationship between 306–7 protocols 315–16 reasons for 305–6 sleep in the ICU 322–3 vicious cycles 317–19 withdrawal 317 withdrawal cycle 319 sedation–agitation cycle 318 sedation–ventilator dyssynchrony cycle 318 Se˛dziwój, Michał 74 selective decontamination of the digestive tract (SDD) 254 selective oral decontamination (SOD) 254 sepsis acute respiratory distress syndrome 372 neutropenic 453–5 signs indicating 29 weaning 337 septic shock 506 serology 45–6, 53 Servo 900A and 900B ventilators 107 sevoflurane 401 sexual dysfunction in ICU survivors 362 sexual exposures 27 Short-Form Health Survey—36 items (SF-36) 367 shunt 17–18 airway pressure release ventilation 153 anatomical (extrapulmonary) 18 effect of cardiac output on 18 intrapulmonary 18 sickle cell disease 25 sickle cell haemoglobin (HbS) 20 Siemens ventilators 107 sildenafil 381, 546, 547 silver-impregnated tracheal tubes 211 sinus infections 256 sinusoidal flow pattern 166 sirolimus 572 skin colour 28 skin perfusion 28 sleep disturbance 23–4 in the ICU 322–3 investigations 48 quality 118 small vessel vasculitis 391–2 Smartcare® 344 smoke inhalation 460–3 smoking carboxyhaemoglobin levels 461 COPD 428, 429 malignancy 509 socio-economic status 429 sodium citrate 467 SOFA 458 speaking valves 220, 229–30 speed of onset of symptoms 24–5 spirometry 35–6 COPD 431 incentive 227 splanchnic perfusion 122 spontaneous breathing airway pressure release ventilation 151–2 BiPAP 156 pressure-controlled ventilation 138–9 trials (SBTs) 336, 340–3 sputum 24, 49–52 squamous cell carcinoma 38 standard base excess 34 standard bicarbonate 34 staphlococcal pneumonia 56–7 Staphylococcus aureus 56–7 static compliance curve 125 static ventilation loops 239–40 stem cell transplantation (SCT) 452–3, 456 complications 453, 454 ICU admission 458 Streptococcus pneumoniae 56 streptokinase 489, 537 streptomycin 525, 526 stridor assessment 29 post-extubation 211–12, 352 stroke 76 Strongyloides stercolaris 425–6 subglottic drainage, tracheal tubes 210 subglottic suction ports, tracheostomy tubes 218 suctioning 224–5 chest drains 554 high frequency oscillatory ventilation 162 physiotherapy 228 tracheostomy tubes 218 sudden deterioration on a ventilator 301–4 sufentanil 273 sulbactam 514 sulfamethoxazole 414, 526 sulfasalazine 416, 439, 443 sunk costs error 66 super syringe method 239 surfactant 202–3, 381 surgical emphysema 484 surgical lung biopsy (SLB) 472–3 surgical tracheostomy 214 surveillance cultures 56 Sutton’s slip 66 suxamethonium 353, 464 swallowing, and tracheostomy 220 Swan–Ganz catheterization 406 synchronized intermittent mandatory ventilation (SIMV) 130–4 history 107 indications 132 initial set up 133–4 physiological effects 131 troubleshooting 132–3 weaning 344 synchrony COPD 436 pressure–time curve used to assess 235–6 system and processes, clinical decision making 65, 67 system errors in diagnosis 64 587 588 INDEX systemic inflammatory response syndrome (SIRS) 337 systemic lupus erythematosus (SLE) 26, 390 systemic sclerosis 26 systemic vasculitis 393 T tacrolimus 416–17 target pressure, pressure control ventilation 114 Taylor-type dispersion, HFOV 158 tazobactam 62, 253, 504, 514 tension pneumothorax 483, 558 thalassaemia 20 thermal injury to the airway 461–2, 463–4 Thigh 154–5 thiopental 518–19 thoracic cage compliance 9–10 thoracic mechanics 115–16 thoracic surgical patients 550–6 analgesia 550 bullous lung disease 555–6 chest drains 553–4 double-lumen tubes 554–5 excess fluid 550–1 post-thoracotomy surgical failure 551–3 re-expansion pulmonary oedema 554 thoracic trauma 557–63 ballistic injuries 560–2 blast injuries 562–3 chest wall injuries 557–8 intra-thoracic injuries 558–60 pleural injuries 558 thoracotomy 551–3 threshold load 121 thrombocythaemia 54 thrombocytopenia 54 thromboembolism 303 thromboprophylaxis 539–40 thyroid function 405 tidal volume acute respiratory distress syndrome 382–3 asynchronies 263–9 monitoring 232 oxygenation, improving 291 pressure-controlled ventilation 115, 135 reliable control 118 volume-controlled ventilation 112 time cycling 110 time triggering 109 Tinsp 138 tissue resistance 10 titration of respiratory support 336–7 Tlow 154–5 TNF-A blocking therapy 420–1 tobramycin 254, 514, 566, 568 tocilizumab 421–2 tocolysis 522–3 tracheal aspirates 252 tracheal gas insufflation 206 tracheal suctioning see suctioning tracheal tube cuffs 210 tracheal tubes see endotracheal tubes (ETTs)/intubation tracheo-bronchial injuries 559 tracheobronchitis 75 tracheobronchomalacia 436–7 tracheostomy 213–21 advantages over ETTs 213 asynchronies 270 changing a tube 218 complications 215–18 emergencies 218–19 history 102, 107 indications 213 long-term ventilation 357–8 non-invasive ventilation 88 percutaneous dilational vs surgical 214 performing a 214 physiotherapy 229 practical advice 214–15 speaking valves 220 swallowing 220 timing 213 weaning and decannulation 220–1 Tracman trial 213 training, non-invasive ventilation 89 transbronchial lung biopsy (TBLB) 47 acute respiratory distress syndrom 378 interstitial lung disease 472 pneumonia 511 transducers 231 transfer of blood components 328 transfer of patients 324–5 aeromedical 328–9 avoiding problems during 325–7 calculating the oxygen requirements 330 checklist 329 equipment 327 high frequency oscillatory ventilation 163 portable transport ventilators 330–1 problems 324–5, 328 ventilatory support, indications for 72 transfusion-related acute lung injury (TRALI) 372–3 transplantation 26 see also specific organs transport of patients see transfer of patients transradiency, chest X-rays 38 trans-thoracic echochardiography (TTE) 536–7, 544–5 trauma haemothorax 487 masks (non-rebreathing masks) 80, 81 thoracic see thoracic trauma travel history 26 treatment of other conditions, ventilatory support to assist 72 triggering 109 assist control ventilation 140, 141–2 asynchronies 263, 264–8, 269, 270 iron lungs 93 neurally adjusted ventilatory assist 178, 179 non-invasive ventilation 86 pressure–time curve used to assess 235 problems 110 pressure support ventilation 144, 145–6, 148–9 synchronized intermittent mandatory ventilation 133 trimethoprim 414, 526 triple triggering 263, 266 INDEX tris-hydroxymethyl aminomethane (THAM) 298, 300 troponin 532 l-tryptophan 439 tuberculosis (TB) bacterial filters 223 chest X-ray 38 corticosteroids 412 microbiology laboratory 60 pleural effusions 486 pregnancy 526 quantiferon-TB gold 60–1 sputum 50 TNF-A blocking therapies 421 tubing, pressure-controlled vs volume-controlled ventilation 117 U ultrasound chest 43–4 lung 43–4 pleural disease 482 pleural effusions 485 pleural infection 489 pulmonary embolism 537 universal precautions, transfer of patients 325 unstable breathing, effects of mechanical ventilation on 259 upper airway muscles obstruction 93, 204, 205 oedema 352 urinary antigens 55 ustekinumab 422 usual idiopathic pneumonia (UIP) 469 V ˙Q ˙ mismatch 153 V/ ˙Q ˙ ratio 15–17 V/ oxygenation, improving 291–2 effect on gas exchange 17 ˙Q ˙ relationships 14–19 V/ V/Q scanning 536 valaciclovir 422 valves CPAP 97–8 speaking 220, 229–30 vancomycin 56, 63, 424, 504, 505, 514 variable performance oxygen delivery devices 80 varicella zoster 422, 525 vasopressin 548 venous admixture 18 venous return 275–6 ventilation 4–6 distribution of 14–15 ventilation complications 244–56 broncho-pleural and alveo-pleural fistulae 246–9 pneumothoraces and air leaks 246 renal and other organ systems 254–5 sinus infections 256 ventilator-associated pneumonia 249–54 ventilator-associated tracheobronchitis 254 ventilator-induced diaphragmatic dysfunction 255 ventilator-induced lung injury 244–6 ventilation curves, monitoring 232–7 ventilation load 335 ventilation loops, monitoring 237–40 ventilation outside the ICU 324–32 ventilator associated lung injury (VALI) 244, 374–5 ventilator-associated pneumonia (VAP) 249–54, 513 acute respiratory distress syndrome 385 bacterial filters 223 diagnosis 249, 251 heated humidifiers 222, 223 investigation 252 pathogens 250–1 pathophysiology 250 prevention 253–4 risk factors 250 rotational therapy 200, 201 suctioning 225 tracheal tubes 210–11 transfer of patients 325 treatment 252–3 weaning 333 ventilator-associated tracheobronchitis (VAT) 254 ventilator dependency 333 ventilator-induced diaphragmatic dysfunction (VIDD) 255 ventilator-induced lung injury (VILI) 244 pressure-controlled vs volume-controlled ventilation 116–17 PEEP 119 prevention 245–6 ventilator trigger delays 269 ventilators, NIV 90 ventilatory failure, pathophysiology 6–7 ventilatory support, indications for 69–72 VentiPAC ventilator 331 Venturi masks 79–80, 81 Vesalius, Andreas 102, 103 viral pneumonitis 525 viruses 59–60 Vision Alpha 163 Vital Signs® 97 volume control, monitoring 233 volume-controlled ventilation (VCV) 111–13, 116–18 acute respiratory distress syndrome 384 asthma 400 flow patterns 166 pressure-controlled ventilation vs 116–18, 136, 137 volume cycling 110 volume responsiveness, using heart–lung interactions to diagnose 280 volumetric capnography 242 volutrauma 244, 375 voriconazole 425 W warfarin 522, 524, 538 weaning 333–49 adaptive support ventilation 173 airway pressure release ventilation 155 approach 334 BiPAP 157 considerations prior to 337–8 definitions 333 delayed 348–9 extracorporeal membrane oxygenation 186 failure 345–8 high frequency oscillatory ventilation 161 modes 343–5 589 590 INDEX weaning (Cont.) NIV 88 physiotherapy 229 predictors of successful 242, 338–40 pressure support ventilation 149 proportional assist ventilation 176 protocols 343 respiratory capacity and loading 335–6 screen 338 speed of 333–4 spontaneous breathing trials 340–3 synchronized intermittent mandatory ventilation 132, 134 thoracotomy patients 552–3 titration of respiratory support 336–7 tracheostomy 220–1 tracheostomy tubes 220 ventilator-associated pneumonia 253 Wegener’s granulomatosis 391–2, 393, 394, 509 weight loss, COPD 431 Wells score 531 wheeze 29, 431 Whisperflow® 81, 97 work history 27 work of breathing (WOB) adaptive support ventilation 170, 171 airway pressure release ventilation 153 automatic tube compensation 166–7 dual-control ventilatory modes 166 Heliox 204 oxygen consumption, reducing 71 PEEP 120–1 pressure-controlled vs volume-controlled ventilation 117 pressure support ventilation 145, 147 proportional assist ventilation 174 X X-rays, chest see chest X-rays Z zanamavir 423, 507 zaprinast 547 zero PEEP (ZEEP) 120, 125 Ziehl Neelsen stain 50–1, 60 zopiclone 323 ... Specialist Handbooks in Critical Care Advanced Respiratory Critical Care Edited by Martin Hughes Consultant in Intensive Care Medicine Royal In rmary, Glasgow, UK Roland Black Consultant in Intensive... Oxford Specialist Handbooks in End of Life Care End of Life Care in Cardiology End of Life Care in Dementia End of Life Care in Nephrology End of Life Care in Respiratory Disease End of Life Care in. .. Consultant in Respiratory Medicine Royal In rmary, Edinburgh, UK Team Leader in Critical Care Physiotherapy Royal Devon and Exeter Hospital, Exeter, UK Martin Hughes Consultant in Intensive Care Medicine